January 2015
Flavoured Tobacco - A Growing Epidemic
Tobacco Control in
Newfoundland and Labrador
NL ALLIANCE FOR THE CONTROL OF TOBACCO (ACT)
The latest release of the National Youth Smoking Survey (2010-2011) indicates
that a very high number of high school students are using flavoured tobacco
products. The survey indicated that 14% of high school students in Canada used
tobacco in the previous thirty days. Of this 14%, more than half (52%) had used
flavoured tobacco products. These results clearly show that there is an urgent
need for action.
The Federal Tobacco Act prohibits flavours (except menthol) in cigarettes,
cigarillos (little cigars) and blunt wraps. Cigarillos are defined in the Act as
cigars weighing 1.4 grams or less or having a cigarette filter. Tobacco
companies have avoided this definition by increasing the weight of cigarillos to
more than 1.4 grams which allows them to continue to add flavours to the
product and be sold as cigars. Flavours such as chocolate, mint, strawberry,
peach and other sweet variations make the product very attractive to youth and
young adults.
Flavoured products increase the likelihood that our youth will start smoking and
become addicted to tobacco. For this reason, swift action is needed to protect
youth from these products. ACT believes that it is time for the Government of
Newfoundland and Labrador and/or the Government of Canada to amend current
legislation to completely ban all flavoured tobacco.
“These survey results clearly show there is an urgent and compelling need for
federal and provincial governments to ban all flavoured tobacco products,”
says Rob Cunningham, Senior Policy Analyst, Canadian Cancer Society.
“Swift action is needed to protect youth from these products. It is essential
that governments introduce new legislation without delay.”
Electronic Cigarettes
Electronic cigarettes - also called ecigarettes or vapours are quickly
becoming a pressing public health
concern in Canada and around the
world. They are sometimes hyped in
the media as a new tool for smoking
cessation however, there is currently
no scientific evidence to support this
idea. The e-cigarettes are designed to
mimic smoking behavior. When the
user inhales, a small amount of liquid
from the cartridge is drawn into the
atomizer where it turns into vapour.
The vapour is then inhaled into the
lungs giving the user the feeling of
smoking a real cigarette. In Canada
the vapour cartridge is not permitted
to be sold if it contains
nicotine, however the
regulations are not enforced and
many people can obtain nicotine
filled cartridges either online or
while travelling to the United States.
the cartridge. In addition, ecigarettes carry a risk of explosion as
a result of a failure in the battery
unit.
Health Canada and the World
Health Organization do not
recommend the purchase or use of
these products because of the lack of
evidence and testing for safety,
quality and efficacy. In addition, ecigarettes can pose a direct health
risk both to users and children. The
CDC states that reports of nicotine
poisoning in children has increased
dramatically since e-cigarettes have
been on the market—children are
accidentally ingesting the liquid in
This growing popularity of ecigarettes is forcing cities,
businesses and institutions around
the world to take a stand on public
use. In New York City for example,
“vaping” has been banned in bars,
clubs and restaurants. In Canada, the
University of New Brusnwick has
become one of the first educational
institutions to ban the use of ecigarettes in its buildings. In
addition, Air Canada and West Jet
have policies prohibiting e-cigarette
use on their planes.
Hookah (Water-Pipes)
Traditionally, shisha is a tobacco
based mixture that has been
soaked in honey or molasses.
However, due to poor labelling
and claims of being “herbal” or
“non-tobacco”, and establishments
preparing their own shisha
mixtures, it is difficult to
determine the ingredients and the
tobacco/nicotine content of shisha
in today’s Canadian marketplace.
Shisha is available in many
flavours such as apple, chocolate,
mango, and tutti frutti. Some
flavours, such as bubble gum and
cotton candy, appear to be
targeted particularly at young
people.
The availability of candy and fruit
flavoured shisha makes it more
tempting for young people and
can become yet another
inducement to smoking that
appeals to a younger audience.
Many users feel that using a water
-pipe is less harmful than cigarette
smoking because the smoke
passes through water. Smoking
tobacco (or any other organic
material) through water does not
filter out cancer causing
chemicals. Hookah smoke can
damage the lungs and heart as
much as cigarette smoke. Hookah
smoking also poses another
important public health risk. The
act of hookah smoking has
traditionally been a social activity
and remains so today. Because of
this social aspect, the sharing of a
single (or several) hookah pipes
can put users at risk for other
infectious diseases such as
meningitis, tuberculosis, hepatitis
and influenza. The sharing of
mouthpieces and the heated, moist
smoke may enhance the
opportunity for such diseases to
spread . Because there is a
growing body of scientific
evidence suggesting that hookah
smoking poses a public health
concern and that any type of
emissions from water-pipes whether tobacco based or not – are
dangerous both to users and to
those exposed to them, ACT
recommends that all public indoor
use of water-pipes – whatever the
material heated/combusted in
them – be banned under the NL
Smoke Free Environment Act,
2005.
PARTNERS WORKING TOGETHER
Smokers’ Helpline Update— Brief Interventions Work!
The Smokers’ HelpLine CARE
referral program is a brief version of
the Five A’s - (Ask, Advise, Assess,
Assist, Arrange). It is an intervention
that can be completed in less than 2
minutes and ensures that the client/
patient has adequate support and
follow-up through the Smokers’
HelpLine as they quit smoking or
work to maintain their smoke free
status. CARE is an award winning
program that is quick, easy to use and
highly effective. CARE consists of
the following components:
ASK - Ask if your client/patient has
used tobacco within the last six
months
ADVISE - Advise your client/
patient that they can quit and receive
support in quitting and/or staying
smoke free through the Smoker’s
Helpline.
REFER - Refer to the Smoker’s
Helpline by completing a CARE Fax
referral form.
FAX - Fax the completed referral to
the Smokers’ Helpline at 1-709-7262550.
If your patients/clients decline the
referral or are not yet interested in
quitting smoking, provide the
Smokers’ HelpLine toll-free number
and encourage them to call when
they are ready. Counselors are
available on the line from Monday
to Thursday 9:00 a.m.– 9:00 p.m.
and on Friday 9:00 a.m.—5:00 p.m.
Clients can also leave a message
and they will be called back as soon
as a counselor is available.
If you would like to receive a free
CARE referral kit please call the
Smokers’ Helpline to order.
.
Northern Wellness Coalition Blue Lights Campaign
In partnership with the Alliance for the
Control of Tobacco, Labrador-Grenfell
Health, and the Northern Peninsula
Family Centre, the Northern Regional
Wellness Coalition explored a number
of projects that could bring awareness
to the health issue of second-hand
smoke and the importance of smokefree homes. With limited funds, but
user-friendly information adapted from
the Manitoba Lung Association, the
Northern Wellness Coalition sought to
develop a cost-effective version of the
Blue Light Project. The original project
of other organizations and groups had
used blue light bulbs. Unfortunately,
this came at a huge expense. As a
result, the Wellness Coalition chose to
introduce the smoke-free homes
messaging using other means.
An attractive one-page brochure with a
reflective decal was developed around
the project. The literature answered
questions regarding second-hand
smoke, how to make a home smokefree and information for members of
families who want to quit. Since this
was a pilot project with limited funds,
we chose two rural communities in
the Wellness Coalition region: Great
Brehat on the Northern Peninsula and
Port Hope Simpson on the coast of
Labrador.
Wellness Coalition partners hosted
community events with presentations
on second-hand smoke to ensure the
education piece of the project was
received by the communities in
addition to the decal/brochure. The
Blue Light Project was well-received
with the resource delivered to
approximately 250 households.
Families were asked to post the decal
in their front window/door for
visibility thereby spreading
awareness for smoke-free homes. At
night the decals are reflected by all
light – providing further awareness
on second-hand smoke in homes.
With partnerships and support
provided by a number of individuals
and some additional funding from
the Northern Wellness Coalition,
this pilot project was completed for
just under $1000.
Western S.W.A.T. Program
For the past two years, the western
region of the Newfoundland and
Labrador English School District
has partnered with the Tobacco
Free Network to promote Students
Working Against Tobacco
(S.W.A.T.) For 2014, the S.W.A.T.
concept was extended to include
physical activity and healthy living
(Student Wellness Action Teams).
Schools in the western region
received an invitation to send a
teacher and a team of student
leaders to a fun session to help
promote health, wellness, and
student leadership. It is hoped that
student leaders will mentor younger
students and role model positive
behaviors to help others make
healthy choices. Each participating
school received a playground kit
valued at $125, resources for
healthy living, and time to share
ideas about what makes each school
a happy and healthy place. The
Tobacco Free Network (TFN) also
covered the cost of one substitute
day for each participating school in
the western region. To see the
activities used at SWAT sessions,
please go to the SWAT web page.
235 students from 39 schools
attended the 7 SWAT training
sessions offered around the western
region. It is expected that great
work will result from these
S.W.A.T. teams to promote student
health. A special thank you to all
those teachers, public health nurses,
and youth outreach workers who
accompanied students and gave up
their time to attend these sessions.
New Tobacco/Smoking Policies
Over the past few months, some
organizations around the Province
have amended their current
smoking policies. In particular,
Eastern Health has changed its
100% smoke free grounds policy to
include the use of electronic
cigarettes and/or any product that
mimics the use of tobacco. In
addition, In October 2014, the City
of St. John’s amended its smoke
free policy to prohibit smoking by
employees conducting city
business. In this case, city business
is defined as anything done by
employees for the city whether it is
on or off city premises. This policy
also prohibits the use of electronic
cigarettes.
Update from the ACT office
The ACT Board of Directors said
good-bye to a few of its members
this year. Dr. Noreen Fardy, Pat
Murray, Kailey Pauls, and Dawn
Sharpe retired from the ACT Board
as a result of other commitments.
We thank them for their time and
commitment to tobacco control in
Newfoundland and Labrador and
wish them the best in all of their
future endeavors.
As a result of these retirements, the
ACT Board welcomed Janice Field
from Eastern Health, Susan
Haskell, Respiratory Therapist,
Christine Hicks from Central
Health and the Central Tobacco
Awareness Coalition and Mariel
Parcon from Western Health to the
Board of Directors.
In addition, ACT Board and staff
welcomed a new Chair of the
Board, Mr. Scott Antle. Mr. Antle
is the Manager of the
Newfoundland and Labrador Colon
Cancer Screening Program and has
been an ACT Board member for the
past 6 years. His experience and
passion for tobacco control in the
Province will be of great benefit to
the organization and we look
forward to a successful year!
HOT TOPICS
Nicotine Replacement Therapy—An Overview
Cessation medications have been proven to double the chances of quitting and they are even more successful when
they are used in combination with counseling or support programs. The following is an overview of the more popular
medications available for smokers in Newfoundland and Labrador.
Nicotine Patch - Available without a prescription, nicotine patches help to lower the craving for cigarettes by
supplying a constant level of nicotine to the blood stream through the skin. As the brain gets used to the steady supply
of nicotine, people are less dependant on cigarettes. People typically use patch therapy for about 3 months but if
necessary it can be used for longer.
Nicotine Gum - Also available without a prescription , nicotine gum is available in different dosage levels (2mgs for
those who smoke less than 25 cigarettes per day and 4 mgs for those who smoke more than 25 cigarettes per day).
Nicotine gum delivers nicotine intermittently (as the gum is chewed) rather than continuously like the patch, therefore
it must be used properly in order to be effective. Individuals may chew up to 10-15 pieces of the gum daily for
approximately 3 months. Heavy smokers may require longer usage.
Nicotine Inhaler - Not to be confused with the electronic cigarette, the nicotine inhaler is available without a
prescription and consists of a mouthpiece that looks like a hollow tube into which a nicotine cartridge is placed. The
person breathes in the nicotine filled air through the mouthpiece. Through using the inhaler a person inhales about
30% of the nicotine found in a cigarette which helps lessen the craving for cigarettes.
Zyban (Medication, prescription required) - Also known as Buproprion. Zyban is an atypical antidepressant that acts
as a dopamine reuptake inhibitor. It was originally researched and marketed as an antidepressant, however it was later
found to be an effective smoking cessation aid. Zyban may not be a good choice for people who have a history of
seizures, bulimia/and or anorexia, who are taking MAO inhibitors or those who are allergic to buproprion
hydrochloride. You should also avoid Zyban is you are alcohol dependant, or taking other anti-depressants. The most
common side effects of Zyban include dry mouth and difficulty sleeping, - these side effects are usually mild and
temporary.
Champix (Medication, prescription required) - Also known as Varenicline tartrate. Champix is a smoking cessation
medication which works by binding to the nicotine acetylcholine receptor in the nervous system (believed to be
associated with nicotine addiction). Champix is taken orally in strengths of 0.5 and 1.0 mgs with the typical treatment
period for medication being 12 weeks. Some of the side effects of Champix include nausea, abnormal dreams and
constipation. Some individuals who have used Champix have reported adverse reactions such as depression,
aggression, feelings of anger and even suicidal thoughts. If a person experiences any of these side effects or notices
any personality changes they should consult their physician immediately
Studies have shown that medications and NRT’s work best when combined with counseling. Everyone using NRT’s
should call the Smokers’ HelpLine at 1-800-363-5864 for additional help and information.
NATIONAL AND INTERNATIONAL NEWS
Australia - Plain Packaging
According to a study published in
the journal BMC Public Health
earlier this year, plain cigarette
packages do make tobacco "less
appealing." After surveying 640
Brazilian women, researchers from
the University of Waterloo found
that colorful branded packs were
"more likely to receive higher
ratings -- for flavor and appeal, for
example -- than those with the plain
packs." Most recently, Australia has
adopted plain packaging for all
cigarette packages. The new law,
the first of its kind anywhere the
world, came into force despite a
vigorous legal challenge by big
tobacco, which argued that the
legislation infringed on its
intellectual property rights by
banning trademarks. All cigarettes
will now have to be sold in
identical, olive-brown packets
bearing the same typeface and
largely covered with graphic health
warnings. The Australian
government, which has been
encouraging other countries to
adopt similar laws, hopes the new
packaging will make smoking "as
unglamorous as possible”
Smoking in Movies
For decades motion pictures have
been used by tobacco companies as
promotional venues to change social
smoking norms and increase the
acceptability of tobacco use. Most
tobacco appearances are presented in
‘pleasant’ situations to provoke
positive perceptions of smoking and
are often done unknowingly to the
audience.
Over the years, the influence of onscreen smoking imagery on youth
behaviours has been called into
question by health organizations. In
2012, the US Surgeon General
declared a causal association between smoking in films
and youth smoking initiation. Smoking in movies
glamorizes tobacco by associating it with characters
portraying wealth, power, sex and rebellion. This
association sends pro-tobacco messaging to its viewers.
Quite rarely do movies portray the realistic health
consequences associated with smoking.
Roughly 80% of movies viewed worldwide contain
depictions of smoking. In 2012, it is estimated that PG13 films in the US contained nearly as much smoking
imagery (39.8 incidents) as R-rated films (42.1
incidents). Likewise, youth-rated films delivered 14.8
billion tobacco use impressions (calculated by paid
admissions times tobacco incidents) in 2012, increasing
drastically since 2010.
A recent study by the Ontario Tobacco Research Unit
found that 90% of top grossing movies in Canada from
2004 to 2013 were youth rated in Ontario. Fifty-seven
percent of all top grossing movies during that time
contained smoking imagery, and 86% of all movies
with smoking imagery were youth rated. The study
estimated that 92,000 youth smokers in Ontario were
recruited due to exposure to on-screen tobacco use.
Advocates of smoke free movies are asking that the
Film and Video Classification Regulations be amended
to develop stronger content ratings for movies that
depict smoking and tobacco related imagery.
Specifically, that all movies and videos depicting
smoking imagery be classified as Restricted (age 18
and over).
In the interim, any movies or videos that depict tobacco
imagery should incorporate public service
announcements in standard film and video formats and
tobacco warning messages prior to the start of any
feature film.